Marshfield Clinic

The 2021 Census Bureau American Community Survey estimates that there are 55.9 million people ages 65 + residing across the fifty states. Although over 70% of people ages 55 + prefer to age-in-place and live independently, 13 million adults have difficulties living independently and need to receive assistance at home. However, only half of these homes meet the physical needs of people who choose to age-in-place. The use of technology and development of smart homes can support ageing-in-place and independent living. The current study used principles from a constructive grounded theory to analyze 67 interviews of people ages 62–92 to assess how older adults prefer to utilize technology in their homes. The results presented that nearly 85% of the participants are willing to learn and use technology in their homes when the benefits are related to their safety, health and wellbeing, daily chores, and social and emotional connection.

Abstract Background An elevated calcium-phosphate product (CPP), defined as a product of serum calcium and serum phosphate, is a hallmark of CKD-mineral and bone disorder and has been implicated in accelerated coronary artery calcification, arterial stiffness, and left ventricular hypertrophy. These pathological changes contribute to adverse cardiovascular outcomes. While prior studies have shown worse percutaneous coronary outcomes (PCI) outcomes in CKD patients overall, the prognostic impact of CPP levels remains underexplored. The objective is to evaluate post-PCI outcomes in CKD patients with and without hypercalcemia and hyperphosphatemia. Methods A retrospective cohort analysis was conducted using the TriNetX U.S. Collaborative Network, focusing on adult patients with CKD undergoing PCI. Patients were grouped based on serum calcium and phosphorus levels, with those having hypercalcemia and hyperphosphatemia compared to those without. Diagnoses and procedures were identified using ICD-10 and CPT codes. Propensity score matching was applied to account for differences between groups. Post PCI outcomes were analyzed. Primary outcome was all-cause mortality. Secondary outcomes encompass coronary artery bypass grafting (CABG), myocardial infarction (MI), in-stent re-stenosis [redo PCI] and target vessel revascularization, heart failure (HF) exacerbations, and peri-/ post-procedural complications were assessed within a 5-year follow-up period. Kaplan-Meier analysis with log-rank was used for statistical comparisons, with significance set at p<0.05. Results The elevated CPP group was significantly associated with increased post-PCI all-cause mortality [hazard ratio (HR) 1.428], in-stent restenosis [HR 1.589], heart failure exacerbations [HR 1.492], and recurrent angina or MI [HR 1.396]. No significant differences were found in rates of post PCI CABG, periprocedural complications (postprocedural cardiac insufficiency, postprocedural cardiac arrest, postprocedural heart failure, intraoperative cerebrovascular infarction, postprocedural cerebrovascular infarction, and intraoperative cardiac arrest), or redo PCI. Conclusion In this propensity score-matched analysis, elevated CPP in CKD patients undergoing PCI was independently associated with worse outcomes, including higher mortality and cardiovascular event rates. These findings highlight the prognostic value of CPP and the need for closer metabolic monitoring and individualized risk stratification. Abstract Figure

Abstract Background Mitigation of antimicrobial resistance in human and veterinary medicine relies on diagnostics, surveillance, and stewardship. Previously, we reported the prevalence of third-generation cephem-resistant (3GCR) Escherichia coli colonizing humans (3.7%), dogs (13.1%), and cattle (51.5%) in our service area (Ortiz 2022). Here, we present new data using a novel clonotyping method to characterize clonal composition of 3GCR E. coli among these hosts. Methods Previously collected 3GCR E. coli isolates colonizing or infecting humans and dogs, and colonizing cattle in Wisconsin, were analyzed. Clonotyping was performed using a rapid method that detects 7 single nucleotide polymorphisms within two genes (fumC and fimH), yielding results comparable to multilocus sequence typing (Tchesnokova 2016). Only major clonotypes, comprising ≥2% of isolates per host, were included. Clonotype 561, corresponding to the pandemic multidrug-resistant ST131-H30 subclone, was excluded to avoid biasing the human clonal composition. Linear regression was used to compare clonotypes' composition and abundance between host species, and with a national dataset of 474 uropathogenic 3GCR E. coli isolates from humans (courtesy of Prof. E. Sokurenko). Comparisons were made by host species, and by source (Wisconsin vs. national). Results A total of 447 Wisconsin 3GCR isolates were analyzed (human n=220; dog n=140; cattle n=87). Linear regression analysis showed a strong correlation between human and dog clonotypes, and vice versa (R²=0.924, 0.903). Human and dog clonotypes correlated poorly with cattle clonotypes (R²=0.268, 0.353), and cattle clonotypes correlated poorly with those from humans and dogs (R²=0.365, 0.301). Wisconsin human clonotypes correlated strongly with the national human dataset (including clonotype 561; R²=0.977, 0.966). Dogs showed moderate correlation (R²=0.701, 0.674), whereas cattle correlated poorly with the national dataset (R²=0.208, 0.260). Conclusion While cattle harbor a larger reservoir of transferable resistance genes, the clonal composition of 3GCR E. coli in this collection shows significantly greater similarity between humans and dogs than between humans and cattle, or between dogs and cattle. Disclosures Joshua Petrie, PhD, CSL Seqirus: Advisor/Consultant|CSL Seqirus: Grant/Research Support|ModernaTX: Grant/Research Support

BackgroundOlder adults and those with chronic health conditions (CHCs) are at increased risk of severe disease from influenza, SARS-CoV-2 and RSV. We assessed illness severity and impact of influenza, RSV and SARS-CoV-2 in adults with and without CHCs.Overview of Modified Wisconsin Upper Respiratory Symptom Survey – 21 (WURSS-21)MethodsFrom September 2024-March 2025, adults seeking inpatient or outpatient care in the Marshfield Clinic Health System for acute respiratory illness were enrolled and tested for influenza, RSV and SARS-CoV-2. A modified Wisconsin Upper Respiratory Symptom Survey (WURSS-21; Table) was used at enrollment to assess overall illness severity, global illness, symptom severity, and functional impact scores. Mean scores were compared by virus using linear regression adjusted for age group, presence of ICD-10-defined CHC, and days from onset to enrollment. Separate unadjusted models compared mean scores for each virus by age/CHC group (18-64 with no CHCs, 18-49 with CHCs, 50-64 with CHCs, and ≥65 with or without CHCs).ResultsAmong 1731 adults enrolled, 68% had ≥1 CHC. Influenza, RSV and SARS-CoV-2 were detected in 242 (14%), 67 (4%), and 168 (10%) of adults, respectively; 8 co-detections were excluded. The median (interquartile range) age was 47 (33-65) years for influenza, 58 (46-70) years for RSV, and 55 (36-70) years for SARS-CoV-2 cases. Virus specific vaccination was reported by 70 (33%) influenza cases, 6 (10%) RSV cases, and 34 (24%) SARS-CoV-2 cases. Among 1600 adults enrolled in the outpatient setting, 13% were positive for influenza, 4% for RSV and 10% for SARS-CoV-2. Among 123 hospitalized adults, 24% were positive for influenza, 4% for RSV and 6% for SARS-CoV-2. Mean (95% CI) overall severity scores were higher for influenza (4.0 [3.8-4.2]) and RSV (4.2 [3.8-4.6]) than SARS-CoV-2 (3.7 [3.5-3.9]). Mean (95% CI) symptom severity scores were higher for RSV (4.2 [3.8-4.7]) than both influenza (3.7 [3.5-3.9]) and SARS-CoV-2 (3.6 [3.5-3.9]). Mean global rating (5.0 [4.7-5.2]) vs 4.6 [4.3-4.8]) and functional impact scores (4.5 [4.2-4.8] vs 4.0 [3.7-4.3]) were higher for influenza than SARS-CoV-2. For each virus, mean severity scores were similar by age/CHC groups.ConclusionWURSS-21 severity scores differed by virus, but reported illness severity and impact did not differ among adults seeking medical care with and without CHCs for each virus.DisclosuresShivani Nagapurkar, MPH, ModernaTX: Grant/Research Support Oluwakemi Alonge, MPH, CPH, CSL Seqirus: Grant/Research Support|GSK: Grant/Research Support|ModernaTX: Grant/Research Support Emma Viscidi, PhD, MHS, ModernaTX: Employee|ModernaTX: Stocks/Bonds (Public Company) Joshua Petrie, PhD, CSL Seqirus: Advisor/Consultant|CSL Seqirus: Grant/Research Support|ModernaTX: Grant/Research Support Jennifer P. King, MPH, GSK: Grant/Research Support|ModernaTX, Inc.: Grant/Research Support Yoonyoung Park, ScD, Moderna: Employee|Moderna: Stocks/Bonds (Public Company) Gigi Zheng, MD, PhD, ModernaTX: Employee|ModernaTX: Stocks/Bonds (Public Company) Catherine A. Panozzo, PhD, ModernaTX: Employee|ModernaTX: Stocks/Bonds (Public Company) Chelsea Canan, PhD, ModernaTX: Employee|ModernaTX: Stocks/Bonds (Public Company) Meng Wang, PhD, ModernaTX: Employee|ModernaTX: Stocks/Bonds (Public Company) Wen-Hsing Wu, MS, Moderna: Stocks/Bonds (Public Company) Iliana Leony Lasso, n/a, ModernaTX: Employee|ModernaTX: Stocks/Bonds (Public Company) Jennifer K. Meece, PhD, CSL Seqirus: Grant/Research Support|GSK: Grant/Research Support|ModernaTX: Grant/Research Support Evan J. Anderson, MD, Moderna: Stocks/Bonds (Public Company) Huong Q. Nguyen, PhD, MPH, CSL Seqirus: Advisor/Consultant|CSL Seqirus: Grant/Research Support|GSK: Grant/Research Support|ModernaTX: Advisor/Consultant|ModernaTX: Grant/Research Support

Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) is often associated with extensive surgical resection and has traditionally been performed via laparotomy. Data on minimally invasive robotic approaches remain limited. We evaluated surgical safety and survival outcomes of robotic CRS/HIPEC for peritoneal surface malignancies (PSM). A single-center propensity score-matched study was conducted using a prospectively collected database (2018-2025). PSM patients treated with robotic CRS/HIPEC were matched 1:1 to open CRS/HIPEC controls using propensity scores based on age, sex, BMI, histology, and PCI. Of 99 cases, 15 robotic and 71 open CRS/HIPECs were identified. After matching, 15 robotic and 15 open cases were balanced by age, sex, BMI, diagnosis, prior surgical score, and PCI. CC-0/1 rate was 100.0% in robotic and 93.3% in open CRS/HIPEC (p = 1.00). Median blood loss was lower in the robotic group (100mL vs 250mL, p = 0.04). Median hospital stay was shorter after robotic CRS/HIPEC (6 vs 9days, p = 0.05). No differences were observed in major complications (26.7% vs 33.3%, p = 1.00) and reoperation (0.0% vs 6.7%, p = 1.00). No 90-day mortality was observed in either group. Median follow-up was 58months. Median overall survival (not reached vs 52months, p = 0.20) and progression-free survival (not reached vs 42months, p = 0.19) did not differ between robotic and open CRS/HIPEC. In PSM patients with low tumor burden, robotic CRS/HIPEC is not associated with increased morbidity or worse survival. It may offer benefits such as reduced blood loss and shorter hospitalization. Multicenter studies are warranted to optimize patient selection.

Abstract Background Severe COVID-19 results in substantial economic burden and impacts quality of life. Assessing how non-hospitalized COVID-19 impacts health utilities during acute infection and long term is important to estimate the full economic impact of SARS-CoV-2 infection. Methods We analyzed EQ-5D-3L survey data from SARS-CoV-2 infected adults (aged ≥16 years) and children (aged 8-15 years) from three community and household cohorts in the United States (2020-2022). EQ-5D-3L scores were analyzed at three time points after symptom onset or first positive SARS-CoV-2 test result and converted to health utilities on a scale of 0-1 (1=perfect health). Among adults, regression models were used to compare differences in health utility by demographic/clinical characteristics. Results Among 538 SARS-CoV-2 non-hospitalized asymptomatic/symptomatic infections from 575 adults with EQ-5D-3L surveys, mean utilities were near 1 throughout the observation period. During 0-14 days, vaccinated participants had higher health utilities (Beta:0.57, 95% CI:0.07,1.07). Seeking medical care and having gastrointestinal symptoms (vs. none), were associated with lower health utilities (Beta, 95% CI:-0.96, −1.60, −0.31; and −0.76, −1.30, −0.21 respectively). During 15-30 days, unemployment was associated with lower health utility (Beta:-0.64, 95% CI:-1.15,-0.14). During 31-90 days, underlying conditions were associated with lower health utilities (Beta:-0.32, 95% CI:-0.54, −0.09). Results for children were similar to adults. Conclusion Non-hospitalized COVID-19 may have minimal overall impact on quality of life; however, health utilities differed by vaccination status, presence of gastrointestinal symptoms, employment status, and presence of underlying conditions. Vaccination may play an important role in minimizing illness impact from SARS-CoV-2 infection. Key points Severe COVID-19 illness causes substantial economic burden and impacts on quality of life; however, the incidence of non-hospitalized COVID-19 is far greater. Assessing how non-hospitalized COVID-19 impacts health during acute infection and long term is important to understand the full impact of SARS-CoV-2 infection. This study utilizes the EQ-5D-3L, a standardized generic preference-based instrument used in population health studies, to estimate health utilities at multiple time points following SARS-CoV-2 infection. The study also examines demographic/medical characteristics that are associated with health utility over time. While mean health utilities were high for all infection periods regardless of age, health utility was lower at varying time points post-infection among adults who sought medical care, reported gastrointestinal symptoms, were unemployed, and with underlying conditions. Vaccinated adults (vs. unvaccinated) had higher health utility and were less likely to report reduced health. Findings can be used as inputs for economic evaluation and assessing impact of interventions for non-hospitalized SARS-CoV-2 illness, such as vaccination.